| NPI | 1528396710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A16118) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036.144388) |
| 207Q00000X Family Medicine (Licence: NC 2021-03446) | |
| 207Q00000X Family Medicine (Licence: NY 259845) | |
| 207Q00000X Family Medicine (Licence: OK 6303) | |
| 207Q00000X Family Medicine (Licence: MO 2017034845) | |
| 207Q00000X Family Medicine (Licence: MN 63171) | |
| 207Q00000X Family Medicine (Licence: WA OP60775849) | |
| 207Q00000X Family Medicine (Licence: SC 83761) | |
| Enumeration Date | 2009-11-26 |
| Last Update Date | 2026-09-02 |